Provider Demographics
NPI:1861951162
Name:HORTON, COURTNEY ANN
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANN
Last Name:HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14720 MAIN ST NE STE 109
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-8460
Mailing Address - Country:US
Mailing Address - Phone:425-788-4889
Mailing Address - Fax:
Practice Address - Street 1:14720 MAIN ST NE STE 109
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8460
Practice Address - Country:US
Practice Address - Phone:425-788-4889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61192497207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine